Lactante con calcificaciones intracraneales y retinopatía

Intracranial calcifications can have a number of different causes, and the distribution and characteristics they present in neuroimaging can orient the specialist towards one or another. It is important to rule out the most frequent entities that are accompanied by intracranial calcifications, but other more remote genetic causes, such as Coats plus syndrome, should not be overlooked.Ex-premature female Infant with a gestational age of 34 weeks, diagnosed with retinopathy at 9 months after presenting strabismus. At 2 years of age, an MRI scan was performed for right hemiparesis, in which an image suggestive of a neoplasm was initially observed. Upon completion of the study with a cranial computed tomography scan, extensive calcifications were observed predominantly in the basal ganglia along with cystic lesions. After ruling out the most frequent causations of intracranial calcifications, the association between the retinopathy and the neurological features was established, and Coats plus syndrome was confirmed by a genetic study that revealed the presence of two hitherto unreported variants in heterozygosis in the CTC1 gene.Coats plus syndrome is an extraordinarily rare autosomal recessive disease, caused by mutations in the CTC1 gene, which involves the appearance of retinal telangiectasias, brain cysts, calcifications in deep nuclei and leukoencephalopathy, as well as other bone and gastrointestinal conditions. Treatment is symptomatic and the disease has a poor prognosis.Lactante con calcificaciones intracraneales y retinopatia.Introduccion. Las calcificaciones intracraneales pueden tener multiples etiologias, y la distribucion y las caracteristicas que presenten en la neuroimagen pueden orientar hacia unas u otras. Es importante descartar las entidades mas frecuentes que cursan con calcificaciones intracraneales, pero no deben olvidarse otras causas geneticas mucho mas remotas, como el sindrome de Coats plus. Caso clinico. Lactante exprematura de 34 semanas de edad gestacional, diagnosticada de retinopatia a los 9 meses al presentar estrabismo. A los 2 años de edad se realizo una resonancia magnetica por hemiparesia derecha, en la que se observo una imagen sugestiva inicialmente de neoplasia. Al completar el estudio con una tomografia computarizada craneal, se observaron extensas calcificaciones de predominio en los ganglios basales y lesiones quisticas. Tras descartarse las etiologias mas frecuentes de calcificaciones intracraneales, se llego a la asociacion de la retinopatia y la clinica neurologica y se confirmo el sindrome de Coats plus mediante estudio genetico, que revelo la presencia de dos variantes en heterocigosis no documentadas hasta la fecha en el gen CTC1. Conclusion. El sindrome de Coats plus es una enfermedad autosomica recesiva extraordinariamente infrecuente, provocada por mutaciones en el gen CTC1, que supone la aparicion de telangiectasias retinianas, quistes cerebrales, calcificaciones en los nucleos profundos y leucoencefalopatia, ademas de otras afecciones oseas y gastrointestinales. El tratamiento es sintomatico y la enfermedad tiene un mal pronostico.